REPORT ON THE EDUCATION AND RESEARCH OF LYMPHOMA IN CHINA Wen-Qi - PowerPoint PPT Presentation

REPORT ON THE EDUCATION AND RESEARCH OF LYMPHOMA IN CHINA � Wen-Qi Jiang, M.D. Sun Yat-sen University Cancer Center, Shenzhen University School of Medicine �

Overview � ! Education Activity of Chinese Society of Lymphoma, CACA ! Frequencies of Lymphoma Subtypes & NK/T Cell Lymphoma Research in China �

Epidemiology of lymphoma in China � Incidence trend of malignant lymphoma from 1998 to 2008 6.4/100,000 in 1998 and 10-11/100,000 � crude*incidence***** adjusted*incidence* Incidence*(1/10 5 ) � Year �

The Mission of Committee of Malignant Lymphoma, Chinese Anti-cancer Association Revision*of*the* Chinese* Lymphoma* Guideline � NaFonal* EducaFon*&* interpretaFon* Management* of*the*Chinese* of*the*paFents* Lymphoma* Guideline* Commi;ee*of* Malignant* Lymphoma,* Chinese*AnFG cancer*AssociaFon � Further* Tour*of* educaFon*of* lymphoma* the*physicians* experts* Chinese* collaboraFve* group**of* pathology*in* maligant* lymphoma* 4

The Further Education of the Medical Oncologist In China � The interpretation of the Chinese Lymphoma Guideline was carried out in more than 25 cities in China from Sept 2011 to May 2012 Estabolishing 14 training center of lymphoma pathology, training more than 100 pathologists of lymphoma each year. ������������� � ������ ��������� ������ ���������� �������� ��������� ������ �������� �������� ������� ��������� ������� ������ ��������� ������� ������ ������ �������� � ��������� �������� ������ �������� ������� ������� �������� ������ ���� �������

Chinese collaborative group of pathology in maligant lymphoma � • Members of the Chinese collaborative group visit the departments of pathology in more than 80 hospitals with academic exchanges and guidance

Education and Care of Patients with Lymphoma � Homeland-care for lymphoma patients 2011

* Recovery Classroom � ! Recovery Classroom: • Teaching the knowledge of lymphoma • Doctor-patient communication • Good platform for patients’ communication ! Recovery Classroom was held more than 70 times in 37 hospitals

* Website of Homeland-care for lymphoma patients � Website is easy to use, ie: • About me � �� ���������

Lymphoma Hotline � Transfer standardized treatment � & Recovery Classroom, Free Clinic Notice, Web Caution

The Mission of Committee of Malignant Lymphoma, Chinese Anti-cancer Association Revision*of*the* Chinese* Lymphoma* Guideline � NaFonal* EducaFon*&* interpretaFon* Management* of*the*Chinese* of*the*paFents* Lymphoma* Guideline* Commi;ee*of* Malignant* Lymphoma,* Chinese*AnFG cancer*AssociaFon � Further* Tour*of* educaFon*of* lymphoma* the*physicians* experts* Chinese* collaboraFve* group**of* pathology*in* maligant* lymphoma* 11

Overview � ! Education Activity of Chinese Society of Lymphoma, CACA ! Frequencies of Lymphoma Subtypes & NK/T Cell Lymphoma Research in China �

The Relative Frequencies of Lymphoma Subtypes in China: A Nationwide Study of 10002 Cases by the Chinese Lymphoma Study Group (CLSG)

Geographic*distribuFon*of*the*24*insFtutes*

The relative frequencies of NHL and HL subtypes CTCL,rare subtypes, LDCHL, 13, 0% 15, 0% CHL,UC, 25, 0% NSCHL, 338, 3% LRCHL, 67, 1% Lymphoma,UC, 378, HPTCL, 10, 0% MCCHL, 356, 4% 4% ATLL, 13, 0% NLPHL, 55, 1% B-LBL, 172, 2% EATCL, 20, 0% T/NK,UC, 180, 2% MF, 21, 0% CCD30+LPDs, 18, 0% SPTCL, 25, 0% ALCL,ALK-, 90, 1% DLBCL,NOS, 3328, 33% ALCL,ALK+, 157, 2% AITL, 266, 3% PTCL,NOS, 425, 4% ENKTCL, 602, 6% T-LBL, 296, 3% B,UC, 387, 4% HCL, 5, 0% DLBCL,SS, 248, 2% SMZL, 41, 0% LPL, 57, 1% MALTL, 685, 7% BL, 107, 1% NMZL, 99, 1% FL, 551, 6% Total number PCNs, 221, 2% CLL/SLL, 424, 4% of cases:10,002 MCL, 307, 3%

Li XQ, et al. Ann Oncol 2011; 22(suppl 4): iv 141 ! �

The relative frequencies of HL and NHLs Total number of cases : 10,002

The relative frequencies of T/NK-NHL subtypes Total number of cases: 2,138

Clinical features of NK/T cell lymphoma � " Ann Arbor staging I/II > 70% Ann Arbor staging I/II > 70% " CHOP often r CHOP often resistance esistance " M Media OS < 1 y edia OS < 1 year for extra-nasal NK/T cell lymphoma ear for extra-nasal NK/T cell lymphoma " EBV infection � EBER(+) 21-92% EBER(+) 21-92% � EBV infection

NK/T*cell*lymphoma:** different*locaFons,*different*outcomes � N=304 � N=117 � EJH �� 2012 �

Chemotherapy*alone*in*NK/T*cell*lymphoma �

Radiotherapy*alone*in*NK/T*cell*lymphoma �

CMT*in*NK/T*cell*lymphoma �

Treatment failures after radiation therapy of NK/ T cell lymphoma patients with stage I � II � N*=*92,*1976G1994* N=214*(RT*96,*RT+CT*118)*,1987G2009* 5yGOS*40.1%* 5yGOS*72%,*5yGDFS*65%* 5yGDFS*37.8% � 5yGLRF*12%,*5yGSF*25.5%,*5yGOF*32.9%* High%Systemic%failure%suggests%new%chemotherapy%should%be%explored! �

myelosuppression, liver dysfunction hyperglycemia, and LGasparaginaseGbased*salvage*regimen*for* refractory*and*relapsed*ENKTL � ! Refractory and relapsed ENKTL � N=45, 1996-2008 ! 39 pts received RT after CT ! ORR 82.2% (CR 55.6 %, PR 26.7%) ! 3 y-OS and 5 y-OS are both 66.9 % ! The major adverse effects of L-asparaginase were allergic reaction � Ann)Hematol,)2009 �

LongGterm*followGup*results*of*EPOCH*regimen*as* firstGline*therapy*of*NK/T*cell*lymphoma � Huang)H)etc.)Leuk)Lymphoma,)2011 �

LongGterm*followGup*results*of*EPOCH*regimen*as* firstGline*therapy*of*NK/T*cell*lymphoma � 3*yGOS*75% � 3*yGOS*60% � P% =*0.528 � Huang)H)etc.)Leuk)Lymphoma,)2011 �

death GELOX � IFRT � ! Untreated IE/IIE NKTL � N=27 ! ORR 96.3% (CR 74.1%, PR 22.2%) , PD 0 ! 3/4 toxicity � leukopenia(33.3%) and ���������������� (29.6%). No treatment related death ! Medial follow-up 27.37 months � PD 25.9 % � 4 cases of ! 2-year OS and PFS are both 86 % � 3-year OS and PFS are 78% and 75%, respectively � ))))))))))))))))))))))Cai)Q,Huang)H.)etc))))Cancer,)2012 �

Poor*prognosFc*factors*of*NK/T*cell*lymphoma � " � Age > 60 " B symtoms " ECOG PS 2 " LDH � " Local lymph nodes involvement " LTI,bone or cutaneous involvement " High Ki-67 expression " EBV DNA copy numbers �� 6.1×10 7 /ml �

PrognosFc*factors*research*in*China* " Beclin-1 Beclin-1 " A Absolute lymphocyte count (AL bsolute lymphocyte count (ALC) C) " � 2 -MG -MG �

Beclin*1 � " N = 65 N = 65 " In this series, mor n this series, more than 80% e than 80% of patients w of patients wer ere in lo e in low-risk IP w-risk IPI I categor category, but some of them with , but some of them with poor pr poor prognosis ognosis " Lo Low Beclin 1 expr w Beclin 1 expression ession showed a signi sho ed a signi fi fi cant association cant association with the adv with the advanced stage and anced stage and inter intermediate to high IP mediate to high IPI risk I risk " Our model placed patients ur model placed patients into di into di fff er erent risk categories ent risk categories with superior pr with superior predictiv edictive v e value alue than IPI � than IP Autophagy,%2010 �

Absolute*lymphocyte*count*(ALC) � " N = 128 N = 128 " P Patients with lo atients with low AL w ALC C 10 9 /l) at diagnosis tended to (<1.0 (<1.0 × 10 /l) at diagnosis tended to hav have mor e more adv e adverse clinical featur erse clinical features es " U Using the IP sing the IPI, PTI, or KP I, PTI, or KPI for I for nasal NK/T-cell lymphoma, the nasal NK/T -cell lymphoma, the majority of patients w majority of patients wer ere in the lo e in the low- w- risk categor risk category (with no or one y (with no or one adverse factor). AL adv erse factor). ALC was helpful to C was helpful to di di fff er erentiate the lo entiate the low-risk patients w-risk patients with di with di fff er erent sur ent surviv vival outcomes. al outcomes. Ann%Oncol,%2011 �

� 2 -MG -MG � " N = 82 N = 82 " S um � 2 -MG Ser erum -MG ≥ 2.5 mg/L was signi 2.5 mg/L was signi fi fi cantly cantly associated with poor OS and PFS associated with poor OS and PFS " For patients with early stage, ser um � 2 - MG or patients with early stage, serum - MG at diagnosis could also help to distinguish at diagnosis could also help to distinguish those with fav those with favorable outcomes fr orable outcomes from those with om those with poor outcomes. � poor outcomes. Ann%Hematol,%2012 �